HESI MS HESI Medical and Surgical Exam - Set 5 - Part 2

Correct Answer: Begin IV normal saline hydration to promote renal calcium excretion

IV normal saline hydration is the first-line treatment for hypercalcemia. Volume expansion dilutes serum calcium and increases renal blood flow, promoting calciuresis — excretion of calcium in the urine. This rapidly lowers serum calcium levels and addresses the dehydration that worsens hypercalcemia. Loop diuretics may follow to further enhance excretion. Option a is incorrect because administering calcium supplements when serum calcium is already dangerously elevated would further increase levels; calcium supplementation is used in hypocalcemia, the opposite condition. Option c is incorrect because while weight-bearing activity reduces bone resorption over time, the immediate treatment priority for serum calcium of 12.8 mg/dL is pharmacological intervention, not ambulation. Option d is incorrect because dietary protein restriction does not directly lower serum calcium in myeloma-related hypercalcemia, which is driven by osteoclast-activating factors rather than dietary calcium or pro

Correct Answer: Antihistamines and corticosteroids should be stopped at least five days before testing

Antihistamines and corticosteroids suppress the immune response and will blunt the wheal-and-flare reaction used to interpret allergy skin test results. Stopping these medications at least five days before testing ensures the immune system responds normally to allergen challenges and produces readable results. Option a is incorrect because taking antihistamines on the day of the test would suppress the skin reaction and produce false-negative results; antihistamines must be stopped well before the appointment. Option b is incorrect because beta blockers affect anaphylaxis management but the primary pre-testing medication adjustment involves antihistamines and corticosteroids; a one-week beta blocker cessation is not the standard teaching focus for skin testing. Option c is incorrect because allowing the client to continue antihistamines or corticosteroids before skin testing will falsely suppress results and lead to inaccurate interpretation of allergen sensitivity.

Correct Answer: Hemorrhagic cystitis from acrolein irritation of the bladder mucosa

Cyclophosphamide is metabolized to acrolein, a toxic byproduct that accumulates in the bladder and causes direct mucosal irritation and hemorrhage, a complication known as hemorrhagic cystitis. Prevention requires aggressive hydration before and after the drug, frequent voiding, and sometimes administration of mesna to neutralize acrolein. Option a is incorrect because cyclophosphamide's primary bladder toxicity is caused by the acrolein metabolite acting locally on the mucosal lining, not by renal tubular accumulation producing systemic nephrotoxicity. Option b is incorrect because although immunosuppression increases UTI risk, the timing of hematuria at the end of cyclophosphamide infusion points to the known direct chemical irritation of the bladder mucosa by acrolein, not a new infection. Option d is incorrect because bladder perforation from irrigation is a mechanical complication associated with surgical procedures such as TURP; it is not associated with intravenous chemothe

Correct Answer: SIADH from ectopic ADH production by the lung tumor

Small cell lung cancer is the malignancy most commonly associated with ectopic ADH production. The tumor secretes ADH autonomously, causing water retention, dilutional hyponatremia (Na 114 mEq/L), weight gain, and concentrated urine. A serum sodium this low can provoke seizures, as seen in this scenario. Management includes fluid restriction and, in severe cases, hypertonic saline. Option a is incorrect because hypercalcemia from bone metastasis produces elevated serum calcium with polyuria and neurological symptoms such as confusion, not the dilutional hyponatremia with concentrated urine seen here. Option b is incorrect because cerebral metastasis may cause neurological symptoms but does not produce the consistent laboratory pattern of low serum sodium, weight gain, and high urine osmolality characteristic of SIADH. Option c is incorrect because tumor lysis syndrome produces a distinctive metabolic triad of hyperkalemia, hyperphosphatemia, and hyperuricemia with secondary hypocalcemi

Correct Answer: Banana, avocado, and kiwi

Banana, avocado, and kiwi share allergenic proteins structurally similar to those in natural rubber latex, a phenomenon called latex-fruit syndrome. Clients with latex allergy who consume these fruits may experience oral allergy syndrome or systemic reactions. Pineapple and papaya are also commonly cross-reactive tropical fruits. Option a is incorrect because berries such as strawberries, blueberries, and raspberries are not among the foods with documented cross-reactive proteins to natural rubber latex; they are not part of the latex-fruit syndrome group. Option b is incorrect because apples, grapes, and pears do not contain proteins that cross-react significantly with natural rubber latex; the latex-fruit syndrome specifically involves tropical and subtropical fruits. Option d is incorrect because stone fruits such as peaches, plums, and cherries are associated with birch pollen cross-reactivity (oral allergy syndrome from tree pollen), not with latex cross-reactivity.

Correct Answer: Periorbital edema in the morning with sensation of collar tightness

Periorbital edema that is most pronounced in the morning — when the client has been lying flat — combined with a sensation of collar tightness from venous congestion in the neck are the classic early signs of SVC syndrome. These findings reflect increasing venous pressure in the superior vena cava territory and require immediate provider notification to initiate treatment before airway compromise develops. Option a is incorrect because bilateral ankle edema worsening throughout the day suggests dependent venous insufficiency or cardiac causes rather than the gravitational positional pattern of SVC syndrome, which is worst after recumbency. Option b is incorrect because mild anemia with fatigue is a common finding in advanced malignancy and does not specifically indicate SVC syndrome; the hemoglobin value alone does not trigger the SVC alarm. Option c is incorrect because bilateral expiratory wheezing may indicate bronchospasm or airway compression but is a later finding in SVC syndrome

Correct Answer: Plasmapheresis removes circulating anti-GBM autoantibodies from the blood

Goodpasture's syndrome is caused by autoantibodies targeting the alpha-3 chain of type IV collagen in the glomerular and alveolar basement membranes. Plasmapheresis removes these circulating anti-GBM antibodies from the plasma, halting ongoing immune-mediated destruction of the kidneys and lungs and allowing time for immunosuppressive therapy to suppress further antibody production. Option a is incorrect because plasmapheresis is a blood purification technique that separates and removes plasma contents; it does not repair or replace glomeruli, which are anatomical structures that require healing through reduction of immune injury. Option c is incorrect because plasmapheresis removes substances from plasma — it does not deliver medications; corticosteroids are administered systemically through separate pharmacological routes and reach inflamed tissue through normal circulation. Option d is incorrect because filtering urea and creatinine is the function of hemodialysis or continuous

Correct Answer: Without intrinsic factor from the stomach, oral B12 cannot be absorbed

Vitamin B12 absorption in the terminal ileum requires intrinsic factor, a glycoprotein secreted by gastric parietal cells. In pernicious anemia, autoimmune destruction of parietal cells eliminates intrinsic factor production, making oral B12 unabsorbable regardless of dose. Monthly intramuscular or subcutaneous injections bypass the gastrointestinal barrier entirely. Option a is incorrect because rapid absorption is not the mechanism of failure; the problem is the complete inability to absorb oral B12 in the absence of intrinsic factor, not a kinetic or uptake issue once absorbed. Option b is incorrect because gut bacteria do not significantly destroy dietary or supplemental B12 under normal conditions; the absorption failure in pernicious anemia is due to absent intrinsic factor, not bacterial degradation. Option d is incorrect because vitamin B12 is a stable water-soluble vitamin that survives passage through the stomach; the absorption failure is receptor-mediated, depending on intr

Correct Answer: Tumor lysis syndrome releasing intracellular contents into plasma

Tumor lysis syndrome occurs when massive cell death releases intracellular contents into the circulation. The characteristic pattern is hyperkalemia, hyperphosphatemia, hyperuricemia, and hypocalcemia (calcium binds the excess phosphate). Oliguria and rising creatinine reflect uric acid crystal deposition in the renal tubules. This is an oncological emergency requiring aggressive IV hydration and allopurinol. Option a is incorrect because hyperparathyroidism elevates serum calcium through PTH-driven bone resorption and renal reabsorption; it does not produce the pattern of high potassium, phosphorus, and uric acid with low calcium seen here. Option b is incorrect because cisplatin nephrotoxicity causes wasting of electrolytes — low potassium, magnesium, and calcium — not the elevated potassium, phosphorus, and uric acid pattern that characterizes intracellular release in tumor lysis. Option c is incorrect because SIADH produces dilutional hyponatremia with weight gain and concentrated

Correct Answer: Creatinine of 3.1 mg/dL, up from 0.9 mg/dL three days ago

Cyclosporine is highly nephrotoxic, and a creatinine rise from 0.9 to 3.1 mg/dL — more than triple the baseline — indicates acute kidney injury requiring immediate provider notification. Dose adjustment or temporary discontinuation may be necessary to prevent permanent renal damage. Routine cyclosporine monitoring includes serum creatinine and drug levels. Option a is incorrect because a blood glucose of 108 mg/dL is mildly elevated after a meal but does not represent an urgent laboratory abnormality; while cyclosporine can contribute to glucose dysregulation, this value does not require immediate contact. Option b is incorrect because mild anemia with a hemoglobin of 10.2 g/dL is common in the early post-transplant period and, while it warrants monitoring, does not represent the acute renal crisis that the rising creatinine does. Option d is incorrect because a platelet count of 140,000 per microliter on day 30 post-transplant reflects recovering marrow function and is within an accep

Correct Answer: Thick, dried mucous plug occluding the tracheostomy tube

A mucous plug obstructing the tracheostomy tube creates an acute airway obstruction in a client who has no alternate air pathway after total laryngectomy — the nose and mouth are no longer connected to the trachea. This is a life-threatening emergency requiring immediate suctioning and humidification. Airway patency takes absolute priority over all other findings. Option a is incorrect because visible secretions at the stoma opening indicate normal secretion production that is manageable through routine suctioning; this is expected in the early postoperative period and does not signal obstruction. Option b is incorrect because whiteboard communication is the expected alternative for a laryngectomy client who can no longer speak; this indicates the client is conscious and adapting appropriately, not experiencing a complication. Option c is incorrect because a red, moist stoma edge is a normal appearance in the early postoperative period as the wound heals around the permanent stoma; it

Correct Answer: Use the epinephrine auto-injector immediately into the outer thigh

Epinephrine is the first-line treatment for anaphylaxis and must be administered immediately when throat tightening and wheezing develop, as these indicate airway compromise. The auto-injector is used in the outer thigh — through clothing if necessary — and 911 is called after injection. Delays in epinephrine administration increase the risk of fatal anaphylaxis. Option a is incorrect because diphenhydramine is a second-line antihistamine that does not reverse bronchospasm or laryngeal edema; taking it before epinephrine wastes critical time when airway compromise is already present. Option b is incorrect because calling 911 before using epinephrine delays the only drug that can reverse anaphylactic shock; epinephrine must be injected immediately, and emergency services called simultaneously or immediately after. Option d is incorrect because ice and antihistamines are appropriate for localized allergic reactions, not anaphylaxis; throat tightening and wheezing indicate systemic anaphy

Correct Answer: Blood tests for Lyme disease are unreliable in the first four to six weeks after exposure

The antibody response to Borrelia burgdorferi develops over four to six weeks after infection. In the first weeks, serology tests frequently produce false-negative results because antibody titers have not yet reached detectable levels. Lyme disease in its early stage is a clinical diagnosis based on exposure history, the characteristic erythema migrans rash, and symptoms — and antibiotics are started without waiting for serological confirmation. Option a is incorrect because the exact opposite is true; blood tests within 48 hours of a bite are almost universally negative because the immune system has not yet produced detectable antibodies, making early serology unreliable. Option c is incorrect because early Lyme disease is treated on clinical grounds without waiting for laboratory confirmation; the characteristic rash and exposure history are sufficient to begin antibiotic therapy and avoid disease progression. Option d is incorrect because a negative blood test in the first weeks of

Correct Answer: Severe odynophagia making swallowing even liquids painful

Radiation to the esophagus inflames the mucosal lining, producing esophagitis that causes severe pain with swallowing — odynophagia — and dysphagia. This typically peaks around weeks two to four of treatment. Management includes topical anesthetics, soft or liquid diet modification, and analgesics, with nutritional support if adequate intake cannot be maintained. Option a is incorrect because fever with productive cough suggests pneumonia, which could be a radiation-induced pulmonary complication but is distinct from esophagitis; the target organ in this scenario is the esophagus, not the lung. Option b is incorrect because bilateral lower extremity edema is not associated with esophageal radiation; it suggests systemic conditions such as venous insufficiency, cardiac compromise, or hypoalbuminemia from nutritional depletion. Option d is incorrect because facial flushing and pruritus after treatment sessions suggest a hypersensitivity or skin reaction rather than the mucosal inflammati

Correct Answer: Assess for tacrolimus neurotoxicity including confusion, seizure risk, and headache

Tacrolimus causes neurotoxicity even at therapeutic drug levels. Tremors, difficulty concentrating, headache, and seizures are recognized manifestations of tacrolimus-induced neurotoxicity. Hypertension is also a common adverse effect. The nurse should perform a focused neurological assessment, document the findings, and report them to the provider who may consider dose adjustment or conversion to an alternative agent. Option a is incorrect because the problem statement specifies the trough level is within therapeutic range, making acute rejection due to subtherapeutic levels an unlikely explanation for these findings. Option b is incorrect because while electrolyte imbalances can cause tremors, tacrolimus-induced neurotoxicity is the more direct explanation given that the client is on a known neurotoxic agent and presenting with the characteristic symptom cluster. Option c is incorrect because cardiac arrhythmias produce symptoms such as palpitations, syncope, and irregular pulse rath

Correct Answer: Bence Jones protein consists of immunoglobulin light chains secreted by malignant plasma cells

In multiple myeloma, clonal plasma cells produce excessive amounts of a single abnormal immunoglobulin. The light chain component of this paraprotein is small enough to pass through the glomerular filtration barrier and appears in the urine as Bence Jones protein. Its presence confirms the plasma cell dyscrasia and contributes to renal tubular injury through cast nephropathy. Option b is incorrect because Bence Jones protein is urinary light chains specific to plasma cell disorders such as multiple myeloma, not a blood-based lymphoma marker; it is detected in urine, not serum. Option c is incorrect because Bence Jones proteinuria reflects the disease process of multiple myeloma itself — light chain overproduction — rather than chemotherapy-induced tubular toxicity; the source is the malignant plasma cells. Option d is incorrect because Reed-Sternberg cells are the pathognomonic cells of Hodgkin's lymphoma; they are completely unrelated to the plasma cell origin of Bence Jones prot

Correct Answer: Elevate the affected arm above heart level and notify the provider

Swelling and heaviness on the side of axillary node dissection three days postoperatively signal early lymphedema. Elevating the affected arm above heart level promotes lymphatic drainage by gravity. Notifying the provider allows for early intervention such as lymphedema therapy referral before the condition becomes chronic and fibrotic. Option a is incorrect because elevating the arm below heart level promotes pooling of lymphatic fluid rather than drainage; the limb must be elevated above cardiac level to use gravity as a drainage aid. Option b is incorrect because tight compression applied without lymphedema specialist guidance can restrict remaining lymphatic channels and worsen fluid accumulation; graduated compression requires professional fitting after the acute postoperative phase. Option c is incorrect because avoiding the affected arm for blood pressure and venipuncture is a correct and essential precaution to prevent worsening lymphedema, but it does not address the existing

Correct Answer: Seek care immediately if you develop fever, new cough, or unexplained weight loss

A CD4 count of 180 cells per microliter — below the AIDS threshold of 200 — makes this client highly vulnerable to opportunistic infections. Teaching the client to recognize early warning signs such as fever, unexplained weight loss, or new respiratory symptoms and to seek care immediately can prevent progression to life-threatening illness before the immune system responds to antiretroviral therapy. Option b is incorrect because antiretroviral therapy is not curative; it suppresses viral replication and preserves immune function but HIV remains in the body, and lifelong treatment is required to maintain viral suppression. Option c is incorrect because while undetectable viral load significantly reduces transmission risk, barrier protection is still recommended; stating that medication eliminates transmission completely is inaccurate and promotes unsafe practices. Option d is incorrect because a CD4 count below 200 cells per microliter defines AIDS-level immune suppression, requiring a

Correct Answer: Fatty replacement of marrow with markedly reduced hematopoietic cells

In aplastic anemia, the bone marrow fails to produce blood cells because the stem cell population is destroyed or suppressed, leaving the marrow spaces filled with fat rather than active hematopoietic tissue. Biopsy characteristically shows hypocellular or acellular marrow with fatty replacement, contrasting sharply with the hypercellular marrow seen in leukemia or myelodysplasia. Option a is incorrect because hypercellular marrow with increased blasts indicates acute leukemia, not aplastic anemia; aplastic marrow shows hypocellularity with fat replacement rather than overcrowding with immature cells. Option c is incorrect because malignant plasma cell infiltration producing monoclonal protein is the hallmark of multiple myeloma on bone marrow biopsy; this pattern is distinct from the acellular fatty marrow of aplastic anemia. Option d is incorrect because fibrous replacement of marrow indicates myelofibrosis, a myeloproliferative disorder; aplastic anemia is characterized by fatty rep

Correct Answer: Chemotherapy nadir, the expected low point of blood counts after treatment

The nadir is the period of maximum bone marrow suppression following chemotherapy, typically occurring seven to fourteen days after drug administration. All three cell lines decrease as the chemotherapy kills rapidly dividing hematopoietic precursors. This expected low point requires monitoring for infection (from neutropenia), bleeding (from thrombocytopenia), and anemia. Counts recover as the marrow regenerates. Option a is incorrect because tumor lysis syndrome presents with metabolic derangements — hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia — rather than the pancytopenia pattern seen at the expected nadir phase. Option b is incorrect because graft-versus-host disease is a complication of allogeneic transplantation, not a side effect of rituximab; R-CHOP is a chemotherapy regimen and does not involve donor immune cells. Option c is incorrect because the timing — day 14 of cycle two — is the classic nadir window for CHOP-based regimens; attributing the pancytopenia